STOCK TITAN

[Form 4] Banc of California, Inc. Insider Trading Activity

Filing Impact
(High)
Filing Sentiment
(Very Negative)
Form Type
4

Banc of California Form 4 summary: Multiple Warburg Pincus-related reporting persons disclosed sales of Non-Voting Common Equivalent (NVCE) stock in Banc of California (BANC). On 09/05/2025 the Purchasers sold 4,500,000 NVCE shares at $16.38 per share under Rule 144, and on 09/08/2025 they sold 1,150,000 NVCE shares at $16.38 in a private sale to the issuer. The filings show indirect beneficial ownership of 4,297,470 shares after the first sale and 3,147,470 shares after the second.

The reporting persons are a group of Warburg Pincus funds and affiliates that identify as directors and 10% owners. The filing references Exhibit 99.1 and is signed on 09/09/2025. Todd Schell is noted as a director designated by the Reporting Persons.

Riepilogo del Modulo 4 di Banc of California: Diversi soggetti segnalanti collegati a Warburg Pincus hanno comunicato la vendita di azioni Non-Voting Common Equivalent (NVCE) di Banc of California (BANC). Il 05/09/2025 gli acquirenti hanno venduto 4.500.000 azioni NVCE a $16,38 per azione ai sensi della Rule 144, e l'08/09/2025 hanno ceduto 1.150.000 azioni NVCE a $16,38 in una vendita privata all'emittente. Le comunicazioni indicano una partecipazione di beneficio indiretta di 4,297,470 azioni dopo la prima vendita e di 3,147,470 azioni dopo la seconda.

I soggetti segnalanti sono un gruppo di fondi e affiliati di Warburg Pincus che si identificano come amministratori e detentori del 10%. Il filing fa riferimento all'Esibizione 99.1 ed è firmato il 09/09/2025. Todd Schell è indicato come amministratore designato dai soggetti segnalanti.

Resumen del Formulario 4 de Banc of California: Vari sujetos informantes vinculados a Warburg Pincus divulgaron ventas de acciones Non-Voting Common Equivalent (NVCE) de Banc of California (BANC). El 05/09/2025 los compradores vendieron 4.500.000 acciones NVCE a $16,38 por acción bajo la Rule 144, y el 08/09/2025 vendieron 1.150.000 acciones NVCE a $16,38 en una transacción privada al emisor. Los registros muestran una propiedad beneficiaria indirecta de 4,297,470 acciones tras la primera venta y de 3,147,470 acciones tras la segunda.

Los sujetos informantes son un grupo de fondos y afiliados de Warburg Pincus que se identifican como directores y propietarios del 10%. El filing hace referencia al Anexo 99.1 y está firmado el 09/09/2025. Todd Schell figura como director designado por los sujetos informantes.

Banc of California 양식 4 요약: Warburg Pincus 관련 여러 보고자가 Banc of California(BANC)의 Non-Voting Common Equivalent(NVCE) 주식 매도를 공시했습니다. 2025-09-05에 매수자들은 Rule 144에 따라 NVCE 주식 4,500,000주를 주당 $16.38에 매도했으며, 2025-09-08에는 발행사에 대한 사적 매매로 NVCE 주식 1,150,000주를 주당 $16.38에 처분했습니다. 보고서에는 첫 매도 후 간접적 실질 보유가 4,297,470주, 두 번째 매도 후 3,147,470주로 기재되어 있습니다.

보고자는 이사회 구성원 및 10% 보유자로 식별되는 Warburg Pincus 계열 펀드 및 계열사 그룹입니다. 제출서류는 부속서 99.1을 참조하며 2025-09-09에 서명되었습니다. Todd Schell은 보고자들이 지정한 이사로 기재되어 있습니다.

Résumé du formulaire 4 de Banc of California : Plusieurs personnes déclarantes liées à Warburg Pincus ont divulgué des ventes d'actions Non-Voting Common Equivalent (NVCE) de Banc of California (BANC). Le 05/09/2025, les acheteurs ont vendu 4 500 000 actions NVCE à 16,38 $ l'action en vertu de la Rule 144, et le 08/09/2025 ils ont vendu 1 150 000 actions NVCE à 16,38 $ lors d'une cession privée à l'émetteur. Les dépôts indiquent une propriété bénéficiaire indirecte de 4,297,470 actions après la première vente et de 3,147,470 actions après la seconde.

Les déclarants constituent un groupe de fonds et affiliés de Warburg Pincus qui se présentent comme administrateurs et détenteurs de 10%. le dépôt renvoie à l'Exhibit 99.1 et est signé le 09/09/2025. Todd Schell est mentionné comme administrateur désigné par les déclarants.

Zusammenfassung Formular 4 von Banc of California: Mehrere meldende Personen im Zusammenhang mit Warburg Pincus meldeten Verkäufe von Non-Voting Common Equivalent (NVCE)-Aktien von Banc of California (BANC). Am 05.09.2025 verkauften die Käufer 4.500.000 NVCE-Aktien zu je $16,38 im Rahmen der Rule 144, und am 08.09.2025 verkauften sie 1.150.000 NVCE-Aktien zu $16,38 in einem Privatverkauf an den Emittenten. Die Einreichungen weisen nach dem ersten Verkauf eine indirekte wirtschaftliche Beteiligung von 4,297,470 Aktien und nach dem zweiten von 3,147,470 Aktien aus.

Die meldenden Personen sind eine Gruppe von Warburg Pincus-Fonds und Tochtergesellschaften, die sich als Direktoren und 10%-Eigentümer ausweisen. Die Einreichung verweist auf Anlage 99.1 und ist am 09.09.2025 unterzeichnet. Todd Schell wird als von den meldenden Personen benannter Direktor genannt.

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Insights

TL;DR: Large, disclosed disposals totaling 5,650,000 NVCE shares at $16.38 reduce Warburg Pincus indirect holdings materially but were conducted under Rule 144 and a private sale.

The transactions represent a total of 5,650,000 NVCE shares sold across two dates for $16.38 per share. The filing clarifies ownership is held indirectly through multiple Warburg Pincus funds and that investment and voting decisions are committee-managed. For investors, the sale documents the change in reported indirect stake sizes without additional operational or financial disclosures about the issuer. The compliance with Rule 144 and the private sale to the issuer are explicitly stated in the filing.

TL;DR: The filing documents arms-length dispositions by substantial holders and reiterates director-by-deputization arrangements for board designation.

The disclosure reiterates that the Reporting Persons may be deemed directors-by-deputization and names Todd Schell as a director. It emphasizes that multiple related fund entities hold the securities indirectly and disclaim direct beneficial ownership except for pecuniary interest. The filing appears procedurally complete, identifies the chain of entities, and attaches Exhibit 99.1 for signatures.

Riepilogo del Modulo 4 di Banc of California: Diversi soggetti segnalanti collegati a Warburg Pincus hanno comunicato la vendita di azioni Non-Voting Common Equivalent (NVCE) di Banc of California (BANC). Il 05/09/2025 gli acquirenti hanno venduto 4.500.000 azioni NVCE a $16,38 per azione ai sensi della Rule 144, e l'08/09/2025 hanno ceduto 1.150.000 azioni NVCE a $16,38 in una vendita privata all'emittente. Le comunicazioni indicano una partecipazione di beneficio indiretta di 4,297,470 azioni dopo la prima vendita e di 3,147,470 azioni dopo la seconda.

I soggetti segnalanti sono un gruppo di fondi e affiliati di Warburg Pincus che si identificano come amministratori e detentori del 10%. Il filing fa riferimento all'Esibizione 99.1 ed è firmato il 09/09/2025. Todd Schell è indicato come amministratore designato dai soggetti segnalanti.

Resumen del Formulario 4 de Banc of California: Vari sujetos informantes vinculados a Warburg Pincus divulgaron ventas de acciones Non-Voting Common Equivalent (NVCE) de Banc of California (BANC). El 05/09/2025 los compradores vendieron 4.500.000 acciones NVCE a $16,38 por acción bajo la Rule 144, y el 08/09/2025 vendieron 1.150.000 acciones NVCE a $16,38 en una transacción privada al emisor. Los registros muestran una propiedad beneficiaria indirecta de 4,297,470 acciones tras la primera venta y de 3,147,470 acciones tras la segunda.

Los sujetos informantes son un grupo de fondos y afiliados de Warburg Pincus que se identifican como directores y propietarios del 10%. El filing hace referencia al Anexo 99.1 y está firmado el 09/09/2025. Todd Schell figura como director designado por los sujetos informantes.

Banc of California 양식 4 요약: Warburg Pincus 관련 여러 보고자가 Banc of California(BANC)의 Non-Voting Common Equivalent(NVCE) 주식 매도를 공시했습니다. 2025-09-05에 매수자들은 Rule 144에 따라 NVCE 주식 4,500,000주를 주당 $16.38에 매도했으며, 2025-09-08에는 발행사에 대한 사적 매매로 NVCE 주식 1,150,000주를 주당 $16.38에 처분했습니다. 보고서에는 첫 매도 후 간접적 실질 보유가 4,297,470주, 두 번째 매도 후 3,147,470주로 기재되어 있습니다.

보고자는 이사회 구성원 및 10% 보유자로 식별되는 Warburg Pincus 계열 펀드 및 계열사 그룹입니다. 제출서류는 부속서 99.1을 참조하며 2025-09-09에 서명되었습니다. Todd Schell은 보고자들이 지정한 이사로 기재되어 있습니다.

Résumé du formulaire 4 de Banc of California : Plusieurs personnes déclarantes liées à Warburg Pincus ont divulgué des ventes d'actions Non-Voting Common Equivalent (NVCE) de Banc of California (BANC). Le 05/09/2025, les acheteurs ont vendu 4 500 000 actions NVCE à 16,38 $ l'action en vertu de la Rule 144, et le 08/09/2025 ils ont vendu 1 150 000 actions NVCE à 16,38 $ lors d'une cession privée à l'émetteur. Les dépôts indiquent une propriété bénéficiaire indirecte de 4,297,470 actions après la première vente et de 3,147,470 actions après la seconde.

Les déclarants constituent un groupe de fonds et affiliés de Warburg Pincus qui se présentent comme administrateurs et détenteurs de 10%. le dépôt renvoie à l'Exhibit 99.1 et est signé le 09/09/2025. Todd Schell est mentionné comme administrateur désigné par les déclarants.

Zusammenfassung Formular 4 von Banc of California: Mehrere meldende Personen im Zusammenhang mit Warburg Pincus meldeten Verkäufe von Non-Voting Common Equivalent (NVCE)-Aktien von Banc of California (BANC). Am 05.09.2025 verkauften die Käufer 4.500.000 NVCE-Aktien zu je $16,38 im Rahmen der Rule 144, und am 08.09.2025 verkauften sie 1.150.000 NVCE-Aktien zu $16,38 in einem Privatverkauf an den Emittenten. Die Einreichungen weisen nach dem ersten Verkauf eine indirekte wirtschaftliche Beteiligung von 4,297,470 Aktien und nach dem zweiten von 3,147,470 Aktien aus.

Die meldenden Personen sind eine Gruppe von Warburg Pincus-Fonds und Tochtergesellschaften, die sich als Direktoren und 10%-Eigentümer ausweisen. Die Einreichung verweist auf Anlage 99.1 und ist am 09.09.2025 unterzeichnet. Todd Schell wird als von den meldenden Personen benannter Direktor genannt.

SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
1. Name and Address of Reporting Person*
WARBURG PINCUS LLC

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
BANC OF CALIFORNIA, INC. [ BANC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/05/2025
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Non-Voting Common Equivalent Stock, par value $0.01/share(1) 09/05/2025 S 4,500,000 D $16.38(2) 4,297,470 I See footnotes(3)(4)(5)(6)(7)
Non-Voting Common Equivalent Stock, par value $0.01/share 09/08/2025 S 1,150,000 D $16.38(8) 3,147,470 I See footnotes(3)(4)(5)(6)(7)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
WARBURG PINCUS LLC

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WP CLIPPER GG 14 L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WP CLIPPER FS II L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS (CALLISTO) GLOBAL GROWTH 14 (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS (EUROPA) GLOBAL GROWTH 14 (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS GLOBAL GROWTH 14-B (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS GLOBAL GROWTH 14-E (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS GLOBAL GROWTH 14 PARTNERS (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WP GLOBAL GROWTH 14 PARTNERS (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WARBURG PINCUS FINANCIAL SECTOR II (CAYMAN), L.P.

(Last) (First) (Middle)
C/O WARBURG PINCUS
450 LEXINGTON AVENUE

(Street)
NEW YORK NY 10017

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Each share of NVCE Stock automatically converts into one share of common stock, par value $0.01 per share, of the Issuer, subject to certain adjustments, upon certain sales or transfers.
2. Reflects the sale of 4,500,000 shares of NVCE Stock by the Purchasers (as defined in footnote 3) at a price per share of $16.38 pursuant to Rule 144 under the Securities Act of 1933, as amended.
3. Reflects securities held directly by (i) WP Clipper GG 14 L.P., a Cayman Islands exempted company with limited liability ("WPGG14 Purchaser") and (ii) WP Clipper FS II L.P., a Cayman Islands exempted company with limited liability ("WPFSII Purchaser" and , together with WPGG14 Purchaser, the "Purchasers"). The equity interests of WPGG14 Purchaser are held by (i) Warburg Pincus (Callisto) Global Growth 14 (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Callisto 14"), (ii) Warburg Pincus (Europa) Global Growth 14 (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Europa 14"), (iii) Warburg Pincus Global Growth 14-B (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Global Growth 14-B"), (iv) Warburg Pincus Global Growth 14-E (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Global Growth 14-E"), (continued on footnote 4)
4. (continued from footnote 3) (v) Warburg Pincus Global Growth 14 Partners (Cayman), L.P., a Cayman Islands exempted limited partnership ("Warburg Pincus Global Growth 14 Partners"), and (vi) WP Global Growth 14 Partners (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Global Growth 14 Partners" and, together with WP Callisto 14, WP Europa 14, WP Global Growth 14-B, WP Global Growth 14-E and Warburg Pincus Global Growth 14 Partners, the "WP Global Growth 14 Funds"). The equity interests of WPFSII Purchaser are held by (i) Warburg Pincus Financial Sector II (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Financial Sector II LP"), (ii) Warburg Pincus Financial Sector II-E (Cayman), L.P., a Cayman Islands exempted limited partnership ("WP Financial Sector II-E"), and (iii) Warburg Pincus Financial Sector Partners II (Cayman), L.P., (continued on footnote 5)
5. (continued from footnote 4) a Cayman Islands exempted limited partnership ("WP Financial Sector Partners II" and, together with WP Financial Sector II LP and WP Financial Sector II-E, the "WP Financial Sector II Funds"). Warburg Pincus (Cayman) Global Growth 14 GP, L.P., a Cayman Islands exempted limited partnership ("WPGG Cayman 14 GP"), is the general partner of each of the WP Global Growth 14 Funds. Warburg Pincus (Cayman) Global Growth 14 GP LLC, a Delaware limited liability company ("WPGG Cayman 14 GP LLC"), is the general partner of WPGG Cayman 14 GP. Warburg Pincus (Cayman) Financial Sector II GP, L.P., a Cayman Islands exempted limited partnership ("WPFS Cayman II GP"), is the general partner of each of the WP Financial Sector II Funds. Warburg Pincus (Cayman) Financial Sector II GP LLC, a Delaware limited liability company ("WPFS Cayman II GP LLC"), is the general partner of WPFS Cayman II GP. (continued on footnote 6)
6. (continued from footnote 5) Warburg Pincus Partners II (Cayman), L.P., a Cayman Islands exempted limited partnership ("WPP II Cayman"), is the managing member of WPGG Cayman 14 GP LLC and WPFS Cayman II GP LLC. Warburg Pincus (Bermuda) Private Equity GP Ltd., a Bermuda exempted company ("WP Bermuda GP"), is the general partner of WPP II Cayman. Warburg Pincus LLC, a New York limited liability company ("WP LLC" and, together with the WP Global Growth 14 Funds, the WP Financial Sector II Funds, WPGG Cayman 14 GP, WPGG Cayman 14 GP LLC, WPFS Cayman II GP, WPFS Cayman II GP LLC, WPP II Cayman and WP Bermuda GP, the "Reporting Persons" and each, a "Reporting Person"), is the manager of the WP Global Growth 14 Funds and WP Financial Sector II Funds. Investment and voting decisions with respect to the securities of the Issuer held by the Reporting Persons are made by a committee comprised of three or more individuals and all members (continued on footnote 7)
7. (continued from footnote 6) of such committee disclaim beneficial ownership of the securities of the Issuer held by the Reporting Persons. Information with respect to each of the Reporting Persons is given solely by such Reporting Persons, and no Reporting Person has responsibility for the accuracy or completeness of information supplied by another Reporting Person. Pursuant to Rule 16a-1(a)(4) of the Exchange Act, each of the Reporting Persons, other than the Purchasers, herein states that this filing shall not be deemed an admission that it or he is the beneficial owner of any of the securities of the Issuer covered by this Statement. Each of the Reporting Persons disclaim their beneficial ownership of such securities except to the extent of its pecuniary interest therein.
8. Reflects the sale of 1,150,000 shares of NVCE Stock by the Purchasers (as defined in footnote 3) at a price per share of $16.38 in a private sale to Issuer.
Remarks:
Solely for purposes of Section 16 of the Exchange Act, each of the Reporting Persons may be deemed a director-by-deputization by virtue of a contractual right to designate a representative to serve on the board of directors of the Issuer. Todd Schell became a director of the Issuer of November 30, 2023. Mr. Schell is a Managing Director in WP LLC's Financials Services group. See Signatures of the Reporting Persons attached as Exhibit 99.1.
See Exhibit 99.1. 09/09/2025
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.
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